Medicare Update: List of Insurers Denying the Most Patients Standard Care
Summary
A new report shows that health insurers in Medicare Advantage, Medicaid managed care, and ACA marketplace plans denied about 12 to 18 percent of requests for standard medical care last year. Many of these denials are later reversed when patients appeal, but appeals do not happen very often.Key Facts
- Insurers denied 12% of prior authorization requests in Medicare Advantage plans.
- Denial rates were higher in ACA marketplace plans at 18%.
- Denial rates varied widely between different insurance companies.
- UnitedHealth Group had a 17% denial rate for Medicare Advantage, while Elevance had 5%.
- Medicaid managed care denial rates ranged from 2% to 23%, depending on the insurer.
- ACA marketplace denial rates ranged from 3% to 25%.
- About 67% of Medicare Advantage denials were overturned after appeal.
- Appeals are uncommon, so many denied requests may not be challenged.
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